www.sepsis.org.nz/action

Sepsis Trust NZConsultation Document

Aotearoa New Zealand National Sepsis Action Plan

AcknowledgementsThis plan would not have been possible without the people who participated in advising on its development, who demonstrated remarkable generosity, openness, and willingness to engage.

We thank the sepsis survivors who contributed their stories, which were at times difficult to express and to hear. 

We acknowledge the reality of inequity in health outcomes for  Māori and Pacific people. In this, we were fortunate to follow in the footsteps of the Ministry of Health’s Achieving Equity in Health Outcomes programme, and to receive the wisdom of present leaders and members of Te Ohu Rata o Aotearoa, the Māori Medical Practitioners’ Association.

Finally, we acknowledge the support of those who have reviewed and endorsed the plan, including the Accident Compensation Corporation Treatment Injury Team, whose support laid its foundations.

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ContributorsContributions to the plan gratefully received from:

• New Zealand Sepsis Trust Board Members

• Te Ohu Rata O Aotearoa (Te ORA)

• Australia and New Zealand Intensive Care Society

• Australasian Society of Infectious Disease

• Australasian College of Emergency Medicine

• NZNO College of Emergency Nurses

• Waikato District Health Board - Sepsis Ready Program

• Paediatric Society of New Zealand

• Health Quality and Safety Commission

• New Zealand College of Midwives

• Sepsis survivors, patients and advocates

• Australian Sepsis Network

• Accident Compensation Corporation (major sponsor)

• Independent facilitator, Dr Margaret Macky

• Representatives from New Zealand academic institutions

• Best Practice Advocacy Centre

• Infection Prevention and Control Nurses College

• New Zealand Private Hospitals Association

• Quality and Patient Safety Executive – Lakes District Health Board

• Medical Research Institute of New Zealand

• Institute of Innovation and Improvement (i3), Waitemata District Health Board

• The Order of St John

• Wellington Free Ambulance

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Acknowledgements i

Contributors ii

Contents iii

Introduction 1

Equity 2

Principles 3

National Sepsis Action Plan – Summary 4

Action One: Create a National Sepsis Network 5

Action Two: Improve Recognition of Sepsis in Healthcare Settings 6

Action Three: Support Sepsis Survivors 7

Action Four: Collect Evidence 8

Action Five: Help the Public to Understand the Importance of Sepsis 9

Timeline 2021 to 2025 10

References 11

Contents

In 2016, infection in New Zealand accounted for over 1 in 3 hospital bed-days and $1.5 billion in direct health spending. Many of these patients will have suffered from sepsis.

The impact of sepsis extends beyond the health system to include loss of income and increased physical dependence which affects whānau, family and carers.

The New Zealand Sepsis Trust was formed to address the gap between what we currently know about sepsis and what we can do to prevent, diagnose and manage it. Our aim is to facilitate cross-disciplinary and multi-sector collaboration. This National Sepsis Action Plan is the outcome of such collaboration.

To facilitate engagement with government, civil society and the public in the development of the sepsis action plan, this document is open for consultation through to March 2021. Leave your feedback at www.sepsis.org.nz/action.

Nāu te rourou, nāku te rourou ka ora ai te iwi “With your contribution and my contribution there lies wellbeing for the people.”

Harvey Duncan, Dr Paul Huggan, Dr Robert Martynoga, Dr Dan Dobbins, CEO Trustee Trustee Trustee

IntroductionA Call to Action

Sepsis (mate whakatāoke) is defined as a life-threatening organ failure caused by a overwhelming immune response to infection. We know that sepsis is under-recognised, which can lead to delayed treatment, prolonged hospital admissions and death in some cases. Sepsis is a preventable illness, an unnecessary drain on resources, and a serious cause of harm to thousands of New Zealanders every year.

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EquityThe National Sepsis Action Plan recognises that inequities in health outcomes for Māori and Pacific patients are not only avoidable but are unfair and unjust. Māori and Pacific people living in Aotearoa experience sepsis rates at least two times that of non-Māori and non-Pacific people. In Aotearoa New Zealand the right to equitable health outcomes for Māori is guaranteed by Te Tiriti o Waitangi. The Treaty principles embedded in the design of this action plan include Mana whakahaere (partnering with Māori leadership), Mana Tāngata (highlighting and addressing inequities), and Mana motuhake (involvement of Māori stakeholders at governance and delivery levels).

The National Sepsis Action Plan also recognises the relationship between sepsis outcomes and the wider determinants of health. In order to implement pro equity actions in this national action plan, the Trust acknowledges that “people with different levels of advantage require different approaches and levels of resources to achieve equity.”

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PrinciplesThe Plan outlines five actions to deliver a vision of “zero harm due to sepsis in Aotearoa New Zealand”. These actions are based on the principles of evidence, equity, efficiency and a commitment to Te Tiriti o Waitangi.

HIGH QUALITY EVIDENCE: Quality Data collection and monitoring is essential to support improvement cycles in healthcare. The Plan will be underpinned by ethnicity, data and analytics that provide rich insights into local problems.

COMMITMENT TO EQUITY: We as a nation have to make a difference in communities most at risk of sepsis, particularly Māori and Pacific people.

VALUE AND EFFICIENCY: NZSAP will prioritise the best use of existing resources before recommending new funding. New money will be invested based on evidence of need, and measurement of outcomes.

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National Sepsis Action Plan – Summary

1. Create a National Sepsis Network 2. Increase Public Awareness a. A National Communication Strategy to Increase Sepsis Awareness b. Deliver “Safe Around Sepsis” Programmes c. Mark World Sepsis Day

3. Improve Recognition of Sepsis in Healthcare Settings a. Implement Sepsis Quality Improvement Programmes b. Audit Sepsis Education and Training Across the Health Sector

4. Collect and Use Quality Data For Improvement a. Establish a Sepsis Data Governance Group b. Conduct a Review of Notifiable Diseases c. Report Sepsis Outcomes by Ethnicity as a Measure of Performance.

5. Support Sepsis Survivors a. Build a Sepsis Registry b. Provide Information and Advice at Discharge from Hospital c. Investigate the Cost of Sepsis

SEPSIS NETWORK

Increase Awareness

RecognitionSurvivor Support

Improvement

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NSN Board

Data Governance

GroupNational Quality

TeamMāori Outcomes

Group

Sponsors

District Health Boards

Action One: Create a National Sepsis NetworkWe need a mechanism that guarantees equitable access to high-quality sepsis care. A National Sepsis Network (NSN) provides this mechanism.

Modelled on the National Trauma Network, the NSN will provide national leadership and create a shared sense of purpose without cumbersome bureaucracy.

The NSN will bring survivor, community and clinical knowledge together. The NSN will report on agreed performance indicators to the Ministry and ACC, with a focus on He Korowai Oranga: The Māori Health Strategy.

The NSN will take a lean approach to project selection and management. Local and regional trials will lead to scaling of programmes proven to work. Data and analytics will identify areas for further investment or disinvestment. The NSN board will link to Crown Agencies and expert working groups, formed and reformed to suit the changing focus of Network activities.

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Action Two: Increase Public AwarenessIn the public mind, sepsis needs to be understood as the final, critical pathway to death and disability caused by infection.

A national communication strategy to increase sepsis awareness will include:

• Consistent, multi-lingual messaging and design• Content for all media - print, web and social• Whānau-centred approaches targeting key groups • Use of community venues and touch points • Partnerships to ensure wide dissemination of material

Deliver “Safe Around Sepsis” Programmes

“Safe Around Sepsis” materials will be provided to schools, rest home staff, kaumātua, senior Pacifica as well as other community settings.

Mark World Sepsis Day

World Sepsis Day will be marked in the calendar of annual health awareness events used by the Ministry of Health. World Sepsis Day will focus on sepsis awareness, annual updates on the Plan’s progress, and stories from around the country about sepsis quality improvement and survivorship.

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Action Three: Improve Recognition of Sepsis in Healthcare SettingsSepsis outcomes hinge on symptom recognition and rapid action. Lack of access to healthcare, lack of awareness of characteristic signs, lack of clarity about escalation pathways, and lack of consumer resources that speak to Māori and Pacific whānau all contribute to delays in treatment.

Implement Sepsis Quality Improvement Programmes

All providers of frontline clinical services will receive training in sepsis recognition, in the use of critical language, and in the use of clinical tools to guide resuscitation. This can be achieved through programmes of quality improvement that are locally developed, properly funded and co-designed with Māori and Pacific consumers and clinicians.

Audit Sepsis Education and Training Across the Health Sector

A detailed audit of sepsis education will identify and systematically address gaps in education and training. This will include understanding of the wider determinants of health, and the long-term impact of sepsis on patients, whānau and carers.

New healthcare workers will not graduate without the ability to recognise and respond to suspected sepsis. Sepsis will be part of postgraduate curricula in healthcare, and become a mandatory component of training provided by employers. This will include providers of community, residential and primary care.

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Action Four: Collect and Use Quality Data For ImprovementChange can occur when data collection and reporting are routine and drive informed decision making.

The example of the National Trauma Network demonstrates the power of data gathering.

The project of the National Sepsis Network will evolve over time. High quality data generates powerful questions and provides answers.

Establish a sepsis data governance group

The data governance group will define mandatory elements of surveillance and reporting. Results will be presented in a searchable format, using a national dashboard. The dashboard will provide insights into numbers of sepsis admissions, survival, and lengths of stay. This will be linked to a broad range of variables including ethnicity, co-morbidity and measures of socio-economic deprivation.

Conduct a review of notifiable diseases

New Zealand does not conduct mandatory surveillance of disease caused by common pathogens such as Staphylococcus aureus, Streptococcus pyogenes and Escherichia coli.

Systems of infectious disease surveillance will be revised to include information on the common causes of sepsis.

Report Sepsis Outcomes as a Measure of Performance

A review of System Level Measures (SLMs) will ensure that high quality sepsis care is embedded in the reporting and planning cycle for District Health Boards. Sepsis has not been included properly in either primary care episode or reported mortality data, nor have surveys of patient experience addressed sepsis survivorship. SLMs provide a natural framework to link the Ministry of Health and District Health Boards together in tackling sepsis.

A limited set of clinical performance indicators will be selected by the NSN.

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Action Five: Support Sepsis SurvivorsFollowing a sepsis event, the greatest decline in function is experienced by:

i) People who were physically independent prior to a sepsis episode ii) People admitted to an intensive care or high dependency unit

Survivors in these groups have a wide range of health problems in recovery, and will be helped by the following actions:

Build a sepsis registry

Registries are designed to provide information that can be used to improve the efficiency and quality of care. Without a registry there is no data on which to monitor patient-focused outcomes (quality of life) or to build a case for investment in survivor support services.

The National Sepsis Registry will require investment in data management and data quality, and will identify variation and areas for improvement.

Provide Information and Advice at Discharge from Hospital

Patients leaving hospital following sepsis have predictable difficulties with physical and cognitive function. Survivors repeatedly refer to how a lack of information contributes to distress and uncertainty. All patients will receive information about their sepsis diagnosis, common problems in recovery, and where to get help. A national advice and support service will be available for survivors and whānau.

Investigate the Costs of Sepsis

Health economic research will quantify the societal cost of sepsis. Recognising whānau as the unit of Māori society, this research will focus on the antecedents and impact of a sepsis event on wider family groups, as well as on individuals.

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Timeline 2021 to 2025

20% drop in ICU sepsis admission for Māori 50% increase in survivor ‘needs being met’

80% community awareness in target population

Roll out primary care and community

programmes

Survivor coordinator

function trialled and reported

Discharge survivor

pack developed

Sepsis ready

programme published by HQSC and seed funding provided

to 50% NZ DHBs

Implementation of whānau

centred community awareness

in one region

Consistent clinical and

data definition used to

create na-tional dash-

board

Data and research

framework established

National Sepsis Action

Network established

Sepsis package developed and

piloted

Sepsis registry

developed and implemented

50% DHBs

Define the baseline

needs and experiences

of sepsis survivors

2021

- 202

220

23-2

024

2023

-202

420

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ReferencesAchieving Equity in Health Outcomes: Summary of a discovery process. Ministry of Health 2019

Achieving Equity in Health Outcomes: Highlights of important national and international papers. Ministry of Health 2018

Achieving Equity (web-page) Ministry of Health. 2019. https://www.health.govt.nz/about-ministry/what-wedo/work-programme-2019-20/

achieving-equity

Robson B, Cormack D, Cram F. (2007) Social and economic indicators. In: Robson B, Harris R, eds. Hauora: Māori Standards of Health IV. A

study of the years 2000-2005. Te Rōpū Rangahau Hauora a Eru Pōmare,

Statement of Intent 2018-2022. Accident Compensation Corporation - available at

https://www.acc.co.nz/assets/corporate-documents/f23bf80b2d/acc7849-statement-of-intent-2018-2022.pdf

Ministry of Health. 2002. He Korowai Oranga: Māori Health Strategy. Wellington: Ministry of Health

Dwyer J. A boy’s life is lost to Sepsis. Thousands are saved in his wake. The New York Times, 13 April 2017.

Gander K. Sepsis: Campaign to raise awareness of UK’s second biggest killer could save 14,000 lives, says charity. The Independent,

22 February 2016

Glaspey LJ, Roberts MB, Mazzarelli A, Trzeciak S, Roberts BW. Early interventions for the prevention of post-traumatic stress symptoms in

survivors of critical illness: protocol for a systematic review. BMJ Open 2017;7(9).

Paul J Huggan, Tania Helms, Veronique Gibbons, Katie Reid, Harry Hutchins, Ian Sheerin. Counting the Cost of Sepsis in New Zealand.

NZMJ (in press)

Paul J Huggan, Anita Bell, James Waetford, Zuzanna Obertova, Ross Lawrenson . Evidence of High Mortality and Increasing Burden of

Sepsis in a Regional Sample of the New Zealand Population ; Open Forum Infectious Diseases, Volume 4, Issue 3, Summer 2017, ofx106,

https://doi.org/10.1093/ofid/ofx106

Improving outcomes for patients with Sepsis. National Health Service England, December 2015.

Jones C, Griffiths RD. Mental and physical disability after Sepsis. Minerva Anestesiol 2013;79(11):1306-12.

New Zealand Major Trauma Registry and National Clinical Network Annual Report 2019

https://www.majortrauma.nz/assets/Publication-Resources/Annual-reports/National-Trauma-Network-Annual-Report-2018-19.pdf

Reinhart K, Daniels R, Kissoon N, et al. Recognising Sepsis as a global health priority – a WHO Resolution. New England Journal of

Medicine 2017; 377:414-417.

Sepsis: recognition, diagnosis and early management. NICE Guideline 51 [NG51]. National Institute for Health and Care Excellence

England, September 2017.

Sepsis Regulations: Guidance Document 405.4 (a) (4). New York State Department of Health, July 2013.

Sepsis Study (survey). The George Institute for Global Health, August 2016.

Stopping Sepsis – A National Action Plan , The George Institute for Global Health. 2017 ( Australian National Sepsis Action Plan )

World Health Organization. The ICD-10: international statistical classification of diseases and related health problems. 10th revision, 2nd

edition. Geneva: World Health Organization, 200

Prescott HC, Angus DC. Enhancing Recovery From Sepsis: A Review. JAMA. 2018;319(1):62–75. doi:10.1001/jama.2017.17687

A National Sepsis Action Plan for Aotearoa New Zealand: Technical Report and Highlights of a National Consensus Process. New Zealand

Sepsis Trust (2020)

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www.sepsis.org.nz/action

Sepsis Trust NZConsultation Document

Aotearoa New Zealand National Sepsis Action Plan

Sepsis Trust NZ Hamilton PO Box No 565

Waikato Mail Centre Hamilton 3240